Anatomical relationship between the sagittal band and extensor tendon of the thumb: a focus on variations of the extensor pollicis brevis tendon insertion

The sagittal band of the finger is an aponeurosis-like structure surrounding the metacarpophalangeal joint. Sagittal band rupture causes extensor tendon dislocation from the dorsal side of the metacarpophalangeal joint. The thumb has two extensor tendons: extensor pollicis longus and extensor pollicis brevis tendons. Multiple studies have reported variations of extensor pollicis brevis tendon insertion. However, it remains unclear how the thumb sagittal band envelopes the extensor pollicis longus and extensor pollicis brevis tendons. This study investigated the anatomical relationship between the sagittal band and the two extensor tendons of the thumb. One hundred hands (47 right, 53 left) from 54 cadavers were examined to assess the detailed structure of the thumb sagittal band and extensor pollicis longus and extensor pollicis brevis tendons. We found that the thumb sagittal band enveloped both the tendons either separately (type I) or collectively (type II). Thirty-four cases (34.0%) were type I and 66 cases (66.0%) were type II. The extensor pollicis longus and extensor pollicis brevis tendons enveloped in the type I thumb sagittal band were inserted on different sites, respectively, whereas those tendons enveloped in the type II thumb sagittal band were inserted on the same sites. This study demonstrated that differences in the type of thumb sagittal band are closely associated with variations in extensor pollicis brevis tendon insertion. We predicted that these differences contribute to the sliding distance between the extensor pollicis brevis and extensor pollicis longus tendons and affect the pathophysiology of extensor tendon dislocation.